clinical patient care

Intradermal (ID) Injection

An intradermal (ID) injection places a small amount of medication into the dermis, just under the skin surface.

15 steps6 criticalLimit 4 minAlways tested

Steps

1Check the order and clarify anything that is unclear
2Critical stepPerform hand hygiene
3Verify the medication against the order, including the expiration date, using the rights of medication administration
4Critical stepCheck that the tuberculin syringe holds the ordered dose (0.1 mL for a TB test)
5Confirm the patient's identity with two identifiers, ask about allergies, and explain the procedure
6Put on nonsterile gloves if contact with blood or body fluids is likely or skin is not intact
7Select a site on the inner forearm, palm side up, free of scars, sores, rashes or other marks that could hide the reaction
8Critical stepClean the site with an alcohol swab in a circular motion and let it dry
9Critical stepHold the skin taut and insert the needle slowly, bevel up, at a 5 to 15 degree angle, just far enough to cover the bevel
10Inject slowly and check that a tense, pale wheal (bleb) forms
11Critical stepWithdraw the needle at the same angle and do not massage, press on or cover the site
12Activate the needle safety feature and place the syringe and needle straight into a sharps container without recapping
13Critical stepRemove gloves and perform hand hygiene
14Teach the patient to return for the reading in 48 to 72 hours
15Document the test, including the injection site, and anything else your facility requires

Tips

The bleb is the visual sign that an intradermal injection went into the dermis.
A TB skin test is read 48 to 72 hours later by measuring the hard, raised area (induration) in millimeters, not the redness.
Skin tests need clear skin: avoid scars, sores and other marks at the site.

Using too steep an angle; the sources call for 5 to 15 degrees with the bevel up.
Massaging, rubbing or bandaging the site.
Measuring redness instead of induration when reading a test.
Telling the patient to come back whenever convenient instead of in the 48 to 72 hour window.

Practice this skill

Practise the sequence with critical-step highlighting and a rationale for each step.

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Sources and how we check them: How we verify.